Monday, February 16, 2009

Gestational Diabetes: What's Up With All the Sugar? סוכרת הריון: מה פתאום

A friend who’s eight months pregnant was describing to me the sugar tolerance tests that pregnant women now routinely take, especially if their babies are large for [their] gestational age. Here are descriptions of the screenings and tests.

I recalled from my pregnancies dutifully drinking 50 cc of pure glucose, or grape sugar guck, the mere thought of which had me paying homage to the nearest toilet. Even back then I recall thinking, “So I (and my baby) am / are ingesting how much sugar? In order to…what? Obtain some number that tells me whether I can or cannot have sugar for the rest of my pregnancy?”

Not only does it seem simpler and less costly for everyone involved to simply advise moms whose babies are large for gestational age to cut back on or cut out sugar from Week 28, but just as I wonder about Gardasil and finding out the gender from an amnio*, I have to ask: Is it necessary? I went looking, and sure enough, found evidence that indeed, it’s not. In addition, it says here:

“Pregnancy makes extra demands on insulin production; to minimize the pressure, pregnant women should eat a diet low in simple sugars, high in complex carbohydrates and fiber, and moderate in fat. Moderate, regular exercise also improves glucose tolerance.”

Sounds reasonable, right? So why do we insist on “fiddling with the works”, especially in the majority of cases wherein no particular concern is indicated?

Once again, my instincts were on target: We simply have a case of a supposed condition whose existence is based on errant information, unnecessary tests for which have been “adopted into the medical canon”. Once again, we have the medical community playing on patients’ fears so that practitioners can protect themselves from blame.

What would be the problem with patients signing an Informed Consent Waiver on tests that they decide they don’t want? I’d sooner have done that than drunk enough liquid sugar to keep my baby bouncing off the walls until first grade.

4 comments:

(mir)Yam,Well, I can not not reply to this one! I hear you and understand you and even, yes, agree with you. But, your view on the issues strikes me as very narrow. Your opinion works more or less, for woman who are healthy, health consience and in a happy pregnancy of a child concived after its parents planned their family carefully. Only 40% of pregnancies, yes 40, are pregnancies that were planned or even wished for. Which does not mean that the child want be loved and cared for, but it does mean that those womans realities are very different. I am not even talking about the global picture of health care but about our own front yard. Last year I worked on numbers of mortality and morbidity of pregnancy outcome between woman who had pregnancy check ups and those with lack of prenatal obstetric care. I agree with you that the philosophy of prenatal care is accented wrong, we keep looking for the bad instead of focussing on the miracle; but I was flabbergasted by the numbers I saw of woman who lack prenatal care. Undetected pregnancy diabetes is not the condition with the worse immediate catastrophic outcomes (preganancy induced hypertension is), but the long time effects of uncared for diabetes can be live long, for mum and baby. Diabetes is an ugly dissease you want to prevent. When you do screening you are not looking for the healthy people you are looking for the high risk ones, the healthy ones at the end were just a waste of money. The obstetrical community is aware of the problems with GTT and GCT and actually Soroka hospital has just finished participating in an 8 year study to find a better way of testing for pregnancy diabetes. Results unfortunately do not seem to be very promising. The fact that health practisioners have to protect themselves from blame is partely the blame of climate created by clients. Woman who do not want to do a test do not have to do a test, not the glucose tolerance test and not any other test. Tests are adviced, the health care providers task is to provide information about the pros and cons of tests so that the women can make an informed decision.You do not need to sign anything for not wanting to do a test, it will be noted in your file that you were offered but are not interested.So: Yes it is a yicky and silly test. I would prefer to offer woman some brownies or a milkshake, at least they would have some fun out of it and more woman would do it I guess. Actually when I was a nurse on a kibbutz, I planned with pregnant woman what they would indigest and have joy from before doing the test. And yes, a lot of health problems would be avoided if the population on a whole would eat healthier. I know it does not apply to you, but believe me that a lot of people do not live and eat healthy, out of choice or because of lack of choice. And saddely true, their is also quite a population who prefers a pill a day instead of altering unhealthy habbits. ( I have some unhealthy habbits myself I can't seem to knock down)I need to go clean the house, since the coocking-cleaning fairy staided only a fantasyLotte Bengal

Yam - perhaps because diabetes treatment is much, much more complicated than "just lay off sugar"? As a diabetic, I find your comment and this post ignorant and narrowminded. I am glad to hear you've never lost a pregnancy due to diabetes, but it's real and it's devastating.

I'm not talking about Type 1 or 2 diabetes, which I understand is much more complex than "just lay off sugar". My dad is diabetic, and my friend died from diabetes-related complications. No argument there. And I did miscarry, though not due to GB. Agreed, it's devastating.

My argument is with across-the-board screenings, especially if, when GB is determined, the woman will in any case be instructed to simply abstain from eating sugar. Why should a woman with no risk factors be ingesting (and by doing so forcing her fetus to ingest) what appears to me to be an unhealthy quantity of sugar?

Nina171 says:

When I got married, I didn’t even consider changing my name. My traditional father said, "I can't believe he's allowing you to do that." I said, "I would never marry someone who would think he had a say in the matter."